Department of Anaesthesia and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
J Reconstr Microsurg. 2011 Sep;27(7):419-26. doi: 10.1055/s-0031-1281524. Epub 2011 Jun 29.
Microvascular flap surgery is a common technique in reconstructive surgery. The wide indications and variable patients provide challenge also for anesthesiologist. Both hypotension and hypoperfusion can be harmful to the flap. Hypotensive patients are treated with fluid resuscitation and vasopressors (e.g., norepinephrine), if needed. As vasoconstrictors, vasopressors might impair microvascular flap perfusion. In this experimental pig model we studied the effect of sevoflurane-induced hypotension on the perfusion of microvascular and superiorly pedicled rectus abdominis myocutaneous flaps. In addition, we evaluated the effect of norepinephrine on flap perfusion when it was used for correction of hypotension. Microdialysis (MD) was used to detect metabolic changes, as it is a sensitive method to detect early changes of tissue metabolism and ischemia in different tissue components of soft tissue flaps. The main finding of this study was that moderate degree of normovolemic hypotension or the use of norepinephrine for the correction of this hypotension did not affect flap perfusion as assessed by MD. More studies are clearly needed to confirm the safety of norepinephrine in clinical use in microsurgery.
微血管皮瓣手术是重建外科中的常用技术。广泛的适应证和多变的患者也给麻醉师带来了挑战。低血压和灌注不足都会对皮瓣造成损害。如果需要，低血压患者可通过液体复苏和血管加压药（如去甲肾上腺素）进行治疗。作为血管收缩剂，血管加压药可能会损害微血管皮瓣的灌注。在这个实验性猪模型中，我们研究了七氟醚诱导的低血压对微血管和上蒂腹直肌皮瓣灌注的影响。此外，我们还评估了当使用去甲肾上腺素纠正低血压时对皮瓣灌注的影响。微透析（MD）用于检测代谢变化，因为它是一种敏感的方法，可以检测软组织皮瓣不同组织成分中组织代谢和缺血的早期变化。这项研究的主要发现是，中度等容性低血压或使用去甲肾上腺素纠正这种低血压不会影响 MD 评估的皮瓣灌注。显然需要更多的研究来证实去甲肾上腺素在显微外科临床应用中的安全性。
